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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �( <br /> RE. 7 A-, PIA WA- 1-4/5''LO Z ld coning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction;CSM <br /> 4971 CC LEST lAL CAR, CRD5S roue wt v.I_-__ • <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 53 , <br /> 7 . - ' —a .-__ , ❑ Site Plan drawn to sca - . <br /> AGENT INFORMATION CONTRACTOR INFORMATION .nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 'Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS �f well/septic <br /> (City,State,Zip) (City,State,Zip) i ❑ Setbaciss <br /> PHONE PHONE S Site PI approval from <br /> P -ppli ble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) \ levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> LI <br /> NUMBER 0�10/0707—lt7.2."$7~' -D g H 3 /5 6 99 rontage drawn to scale. <br /> TOWNSHIP: ff SECTION: rmits <br /> C2c53 PL ix)S lb .1/4: /ow %1/. S E Drivewa e state, oun tY'town) <br /> ADDRESS: <br /> 41-7 U Q Sanitary rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> I 095)— (publi ,private) <br /> PROPOSED PROJECT INFORMATION <br /> L x <br /> PROJECT DESCRIPTION: - . E <br /> �-%{� <br /> . N This project is a new building or structure. ' �r�y - ;� ''' <br /> ❑This project is an addition/alteration to an existing building or structure. ; <br />